Editor's Note: This article is particularly timely because with the uncertain status of gyms nationwide due to fluctuating COVID-19 restrictions, greater numbers of patients may be turning to CrossFit-type outdoor / at-home workouts; while existing CrossFit athletes may be training even harder to compensate for missed events and prepare for events when they resume.
CrossFit athletes: isn't working with them wonderful? And isn't working with them frustrating? It is wonderful working with them because they exercise. I have been trying to get patients to exercise for more than 30 years, and many of them won't do it. Some patients claim they are exercising as recommended, but aren't. Some just tell me they won't exercise.
Either way, their lack of effort is usually obvious. It is evident through protracted recovery time. The fact that patients won't exercise is also evident in national statistics that show one-third of the U.S. population is overweight, while another one third is beyond overweight, obese.
The Challenge
It's no trouble to get CrossFit athletes to exercise. But some exercise to the point of seeming addicted or cultish. The addictive, cultish mentality is the aspect of working with them that is frustrating. They can exercise too much. It is difficult, if not impossible, to get some CrossFit athletes to decrease their exercise volume and intensity, or stop exercising to heal.
When I first encountered the addictive qualities of CrossFit, it took me a bit of time to decipher the problem and address it. Once I had a handle on it, I was able to communicate with these patients more effectively. The result was improved rates of recovery and satisfaction for these athletes.
Understanding the Reality
The key to addressing the problem is patient education. The key to patient education is the ability to get these athletes to step back and take a realistic look at their purpose and goals. They must correlate their purpose and goals with how top athletes train, and how the body functions and repairs.
When the doctor fails to achieve this, rates of recovery decrease, rates of reinjury increase and problems perpetuate. The next step for the patient is doctor hopping.
With few exceptions, the average CrossFit athlete does not receive financial rewards, scholarships, a salary or prize money for their efforts. Most don't have sponsorships. Few have people or organizations that have a stake in their performance. They are competing for and against themselves. Their current or future livelihood is not dependent upon their exercise program.
The opposite is true for many elite athletes. People and organizations do have a vested interest in their performance. Scholarships, salaries and prize money apply to them. The phrases playing hurt, rub some dirt on it, and walk it off apply to them in many circumstances. Many things are at stake, and they must keep going.
Time Off
The average CrossFit athlete can take some time off. Time off can occur without a significant degree of deconditioning taking place. However, recommendations for taking time off frequently fall on deaf ears. Call it commitment, addiction or whatever; this characteristic of CrossFit athletes complicates matters.
Health Care Resources
Another complication is the misconception by CrossFit participants that they are in good shape, which should prevent them from being injured. Referring back to elite athletes, they are in good shape, too, but almost without fail, they have a posse of health care providers available to them during most practices and competitions.
A CrossFit athlete may be working out with the same frequency and intensity as an elite athlete. However, the CrossFit athlete rarely has trainers, physical therapists, chiropractors, PM&R providers, and surgeons at their immediate disposal.
Elite athletes know they can be injured. That is the reason for the health care posse. It is unreasonable for the CrossFit athlete to expect to maintain a high level of exercise frequency and intensity without some degree of injury or the assistance of a health care team. The health care team for an individual CrossFit athlete is much less accessible and, when available, comes at personal cost.
Healing Time
An added complication with CrossFit athletes is their understanding of healing time. Most soft-tissue injuries require six or more weeks to heal. Severe injuries can take even longer. One treatment won't do the trick.
Take, for example, a patient who herniated a lumbar disc while squatting. She could barely walk and was in tears. After her first adjustment, she asked, "I can run tonight, can't I? I have to get five miles in to stay on schedule." She was furious when she was told for the third time during the visit, "No running or lifting for a minimum of two weeks."
The next issue, their lack of reasoning, becomes transformed into the doctor's lack of skills. Their impatience can then result in trying to find a doctor that allows them to do what they want with the doctor remaining at fault for any failures – doctor hopping.
By the time the doctor hopping stops, the amount of time it would have taken to heal initially has passed. The athlete has not adhered to a single treatment program long enough to achieve their desired result.
The Solution: Patient Education
So, with these thoughts in mind, what can assist the CrossFit athlete in recovery? The answer is education. Education must begin at the very beginning of clinical evaluation and management. Everything must be spelled out to the athlete up front. The information cannot be spoonfed to the athlete as treatment proceeds. The following concepts must be made clear:
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